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Research Papers

In Vivo Kinematics of the Tibiotalar and Subtalar Joints in Asymptomatic Subjects: A High-Speed Dual Fluoroscopy Study

[+] Author and Article Information
Koren E. Roach

Department of Orthopaedics,
University of Utah,
590 Wakara Way,
Salt Lake City, UT 84108;
Department of Bioengineering,
University of Utah,
36 S. Wasatch Drive, Room 3100,
Salt Lake City, UT 84112
e-mail: Koren.Roach@utah.edu

Bibo Wang

Department of Orthopaedics,
University of Utah,
590 Wakara Way,
Salt Lake City, UT 84108;
Department of Orthopaedics,
Shanghai Ruijin Hospital,
Shanghai Jiao Tong University
School of Medicine,
Shanghai 200025, China
e-mail: bibo_wang@outlook.com

Ashley L. Kapron

Department of Orthopaedics,
University of Utah,
590 Wakara Way,
Salt Lake City, UT 84108;
Department of Bioengineering,
University of Utah,
36 S. Wasatch Drive, Room 3100,
Salt Lake City, UT 84112;
Scientific Computing and Imaging Institute,
72 S Central Campus Drive, Room 3750,
Salt Lake City, UT 84112
e-mail: Ashley.Kapron@utah.edu

Niccolo M. Fiorentino

Mem. ASME
Department of Orthopaedics,
University of Utah,
590 Wakara Way,
Salt Lake City, UT 84108
e-mail: niccolo.fiorentino@utah.edu

Charles L. Saltzman

Department of Orthopaedics,
University of Utah,
590 Wakara Way,
Salt Lake City, UT 84108
e-mail: Charles.Saltzman@hsc.utah.edu

K. Bo Foreman

Department of Orthopaedics,
University of Utah,
590 Wakara Way,
Salt Lake City, UT 84108;
Department of Physical Therapy,
University of Utah,
520 Wakara Way, Suite 240,
Salt Lake City, UT 84108
e-mail: bo.foreman@hsc.utah.edu

Andrew E. Anderson

Mem. ASME
Department of Orthopaedics,
University of Utah,
590 Wakara Way,
Salt Lake City, UT 84108;
Department of Bioengineering,
University of Utah,
36 S. Wasatch Drive, Room 3100,
Salt Lake City, UT 84112;
Scientific Computing and Imaging Institute,
72 S Central Campus Drive, Room 3750,
Salt Lake City, UT 84112;
Department of Physical Therapy,
University of Utah,
520 Wakara Way, Suite 240,
Salt Lake City, UT 84108
e-mail: Andrew.Anderson@hsc.utah.edu

1Corresponding author.

Manuscript received January 12, 2016; final manuscript received July 14, 2016; published online August 4, 2016. Assoc. Editor: Paul Rullkoetter.

J Biomech Eng 138(9), 091006 (Aug 04, 2016) (9 pages) Paper No: BIO-16-1015; doi: 10.1115/1.4034263 History: Received January 12, 2016; Revised July 14, 2016

Measurements of joint kinematics are essential to understand the pathomechanics of ankle disease and the effects of treatment. Traditional motion capture techniques do not provide measurements of independent tibiotalar and subtalar joint motion. In this study, high-speed dual fluoroscopy images of ten asymptomatic adults were acquired during treadmill walking at 0.5 m/s and 1.0 m/s and a single-leg, balanced heel-rise. Three-dimensional (3D) CT models of each bone and dual fluoroscopy images were used to quantify in vivo kinematics for the tibiotalar and subtalar joints. Dynamic tibiotalar and subtalar mean joint angles often exhibited opposing trends during captured stance. During both speeds of walking, the tibiotalar joint had significantly greater dorsi/plantarflexion (D/P) angular ROM than the subtalar joint while the subtalar joint demonstrated greater inversion/eversion (In/Ev) and internal/external rotation (IR/ER) than the tibiotalar joint. During balanced heel-rise, only D/P and In/Ev were significantly different between the tibiotalar and subtalar joints. Translational ROM in the anterior/posterior (AP) direction was significantly greater in the subtalar than the tibiotalar joint during walking at 0.5 m/s. Overall, our results support the long-held belief that the tibiotalar joint is primarily responsible for D/P, while the subtalar joint facilitates In/Ev and IR/ER. However, the subtalar joint provided considerable D/P rotation, and the tibiotalar joint rotated about all three axes, which, along with translational motion, suggests that each joint undergoes complex, 3D motion.

FIGURES IN THIS ARTICLE
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Copyright © 2016 by ASME
Topics: Kinematics , Rotation , Bone
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References

Figures

Grahic Jump Location
Fig. 1

Tibiotalar (left) and subtalar (right) dynamic joint angles for the individual subjects during captured stance at 1.0 m/s. Dorsi- (+)/plantarflexion (top), inversion/eversion (+) (middle), and internal/external (+) rotation (bottom) were plotted per normalized stance phase with all subjects aligned at heelstrike (0%) and toe-off (100%) for heelstrike and toe-off trials, respectively. Each solid line depicts one representative trial of each subject. Note: separate trials were collected for the heelstrike and toe-off portions of stance as the foot exited the field of view of the fluoroscopes prior to the completion of the entire stance phase. Missing data reflect the portion of stance that was not imaged.

Grahic Jump Location
Fig. 2

Tibiotalar and subtalar mean joint angles during captured stance at 0.5 m/s (left) and 1.0 m/s (right). Dorsi- (+)/plantarflexion (top), inversion/eversion (+) (middle), and internal/external (+) rotation (bottom). Solid line = mean. Shaded areas = 95% confidence intervals. Plotted per normalized stance. Note: separate trials were collected for the heelstrike and toe-off portions of stance as the foot exited the field of view of the fluoroscopes prior to the completion of the entire stance phase. Missing data reflect the portion of stance that was not imaged.

Grahic Jump Location
Fig. 3

Tibiotalar and subtalar mean joint angles during single-leg balanced heel-rise. Dorsi- (+)/plantarflexion (top), inversion/eversion (+) (middle), and internal/external (+) rotation (bottom). Solid line = mean. Shaded areas = 95% confidence intervals. Plotted per normalized heel-rise.

Grahic Jump Location
Fig. 4

Mean (bars = 95% confidence intervals) tibiotalar (gray) and subtalar (white) rotational (left) and translational (right) range of motion (ROM) during 0.5 m/s captured gait (top), 1.0 m/s captured gait (middle) and single-leg balanced heel-rise (bottom). Rotational angles reported per dorsi/plantarflexion (D/P), inversion/eversion (In/Ev), and internal/external rotation (IR/ER). Translational distance travel reported in the medial/lateral (ML), anterior/posterior (AP), and superior/inferior (SI) directions; *p ≤ 0.04.

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